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    Summary
    EudraCT Number:2020-005007-40
    Sponsor's Protocol Code Number:MK-6482-016
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2021-06-23
    Trial results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedSpain - AEMPS
    A.2EudraCT number2020-005007-40
    A.3Full title of the trial
    An Open-label, Multicenter, Phase 2 Study to Evaluate the Efficacy and Safety of Pembrolizumab Plus Lenvatinib in Combination With Belzutifan in Multiple Solid Tumors
    Estudio de fase 2, abierto y multicéntrico para evaluar la eficacia y la seguridad de pembrolizumab más lenvatinib en combinación con belzutifán en diversos tumores sólidos.
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A clinical trial to investigate the safety and efficacy of 3 drug treatments when they are used to treat solid gastric tumors.
    Un ensayo clínico para investigar la seguridad y eficacia de 3 tratamientos farmacológicos cuando se utilizan para tratar tumores gástricos sólidos.
    A.3.2Name or abbreviated title of the trial where available
    Pembrolizumab Plus Lenvatinib in Combination With Belzutifan in Solid Tumors
    Pembrolizumab más lenvatinib en combinación con belzutifán en tumores sólidos
    A.4.1Sponsor's protocol code numberMK-6482-016
    A.5.4Other Identifiers
    Name:INDNumber:153334
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorMerck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.
    B.1.3.4CountryUnited States
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportMerck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationMerck Sharp & Dohme de España SA
    B.5.2Functional name of contact pointInvestigación clínica
    B.5.3 Address:
    B.5.3.1Street AddressCalle Josefa valcárcel, 38
    B.5.3.2Town/ cityMadrid
    B.5.3.3Post code28027
    B.5.3.4CountrySpain
    B.5.4Telephone number+3491321 06 00
    B.5.5Fax number+3491321 05 90
    B.5.6E-mailensayos_clinicos@merck.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameBelzutifan
    D.3.2Product code MK-6482
    D.3.4Pharmaceutical form Film-coated tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNBelzutifan
    D.3.9.2Current sponsor codeMK-6482
    D.3.9.3Other descriptive namePT2977
    D.3.9.4EV Substance CodeSUB207909
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number40
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name KEYTRUDA(pembrolizumab,MK-3475)
    D.2.1.1.2Name of the Marketing Authorisation holderMerck Sharp & Dohme B.V.
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.4Pharmaceutical form Solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNPembrolizumab
    D.3.9.1CAS number 1374853-91-4
    D.3.9.2Current sponsor codeMK-3475
    D.3.9.4EV Substance CodeSUB167136
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number25
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) Yes
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 3
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameLenvatinib
    D.3.2Product code E7080
    D.3.4Pharmaceutical form Capsule, hard
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNLENVATINIB MESILATE
    D.3.9.1CAS number 857890-39-2
    D.3.9.2Current sponsor codeMK-7902
    D.3.9.3Other descriptive nameLENVATINIB MESILATE
    D.3.9.4EV Substance CodeSUB72971
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number4
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 4
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameLenvatinib
    D.3.2Product code E7080
    D.3.4Pharmaceutical form Capsule, hard
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNLENVATINIB MESILATE
    D.3.9.1CAS number 857890-39-2
    D.3.9.2Current sponsor codeMK-7902
    D.3.9.3Other descriptive nameLENVATINIB MESILATE
    D.3.9.4EV Substance CodeSUB72971
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number10
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    HCC, non-microsatellite instability-high (MSI-H)/ deficient mismatch repair (dMMR) CRC, PDAC, and BTC
    CHC, CCR sin inestabilidad de microsatélites alta (MSI-H)/reparación deficiente de emparejamientos erróneos (dMMR), ACDP y CVB.
    E.1.1.1Medical condition in easily understood language
    Liver cancer; Colon cancer; Pancreatic cancer; or Biliary Tract cancer
    Cáncer de hígado; Cáncer de colon; Cáncer de páncreas; o cáncer de vías biliares
    E.1.1.2Therapeutic area Diseases [C] - Cancer [C04]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.1
    E.1.2Level LLT
    E.1.2Classification code 10065252
    E.1.2Term Solid tumor
    E.1.2System Organ Class 100000004864
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    1. To assess the safety and tolerability of the combination of pembrolizumab and lenvatinib and belzutifan.
    2. To evaluate the confirmed objective response rate (ORR) per Response Criteria in Solid Tumors version 1.1 (RECIST 1.1) as assessed by blinded independent central review (BICR).
    1.Evaluar la seguridad y la tolerabilidad de la combinación de pembrolizumab, lenvatinib y belzutifán.
    2.Determinar la tasa de respuestas objetivas (TRO) confirmadas conforme a los criterios RECIST 1.1, según una evaluación central independiente y con enmascaramiento (ECIE).
    E.2.2Secondary objectives of the trial
    1. To evaluate the duration of response (DOR) per RECIST 1.1 as assessed by BICR.
    2. To evaluate disease control rate (DCR) per RECIST 1.1 by BICR.
    3. To evaluate the progression-free survival (PFS) per RECIST 1.1 as assessed by BICR.
    4. To evaluate the overall survival (OS).
    5. To evaluate efficacy outcomes per hepatocellular carcinoma (HCC)-specific modified Response Criteria in Solid Tumors version 1.1 (mRECIST 1.1) (Cohort A) assessed by BICR.
    1.Determinar la duración de la respuesta (DR) conforme a los criterios RECIST 1.1, según una ECIE.
    2.Determinar la tasa de control de la enfermedad (TCE) conforme a los criterios RECIST 1.1, según una ECIE.
    3.Determinar la Supervivencia libre de progresión (SLP) conforme a los criterios RECIST 1.1, según una ECIE
    4.Determinar la supervivencia global (SG).
    5.Determinar los criterios de valoración de la eficacia conforme a los criterios mRECIST 1.1 específicos del carcinoma hepatocelular (CHC) (cohorte A), según una ECIE.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Has histopathologically or cytopathologically documented, advanced solid tumor as follows:
    Cohort A HCC
    Cohort B CRC (non-MSI-H/dMMR)
    Cohort C PDAC
    Cohort D BTC (includes intrahepatic, extrahepatic CCA and gall bladder cancer)
    2. Participant must have progressed on or since the most recent treatment
    3. Has measurable disease per RECIST v1.1 as assessed locally and verified by BICR
    4. Submit an archival tumor tissue sample or newly obtained core or excisional biopsy of a tumor lesion not previously irradiated
    5. Participants must fulfill cohort-specific requirements including prior line of therapies
    6. Is male or female, at least 18 years of age, at the time of signing the informed consent
    7. Male participant is eligible to participate if he agrees to the following during the intervention period with belzutifan or lenvatinib and for at least 7 days after last dose of study intervention with belzutifan or lenvatinib:
    •Be abstinent from heterosexual intercourse
    OR
    • Must agree to use contraception unless confirmed to be azoospermic
    8. A female participant is eligible to participate if she is not pregnant or breastfeeding, and at least one of the following conditions applies:
    • Is not a WOCBP
    OR
    • Is a WOCBP and using a contraceptive method that is highly effective
    9. The participant (or legally acceptable representative if applicable) has provided documented informed consent for the study
    10. Has ECOG performance status of 0 to 1 within 7 days of before the start of study intervention
    11. Has adequate organ function
    12. Has adequately controlled BP with or without antihypertensive medications, defined as BP ≤150/90 mm Hg with no change in antihypertensive medications within 1 week before start of study treatments.
    Cohort A
    13. Has a diagnosis of HCC confirmed by histology, or cytology
    14. Have BCLC Stage C disease, or BCLC Stage B disease not amenable to locoregional therapy or refractory to locoregional therapy, and not amenable to a curative treatment approach
    15. Have a Child-Pugh class A liver score within 7 days before first dose of study intervention
    16. Participants with past or ongoing HCV infection will be eligible for the study. The treated participants must have completed their treatment at least 1 month before starting study intervention
    17. Participants with controlled HBV will be eligible as long as they meet the following criteria:
    •Antiviral therapy for HBV must be given for at least 4 weeks and HBV viral load must be less than 500 IU/mL before first dose of study intervention. Participants on active HBV therapy with viral loads under 100 IU/mL should stay on the same therapy throughout study treatment
    •Participants who are positive for anti-HBc, negative for HbsAg, and negative or positive for anti-HBs, and who have an HBV viral load under 100 IU/mL, do not require HBV antiviral prophylaxis
    18. Has not received any systemic chemotherapy, including anti-VEGF therapy, anti-PD- 1/PD-L1 or any systemic investigational anticancer agents for advanced/unresectable HCC (1L)
    Cohort B
    19. Has histopathological documentation of colorectal adenocarcinoma which is advanced (unresectable and metastatic) and not MSI-H or dMMR as documented by a local test report
    20. Has received at least 2 prior lines of systemic therapy for unresectable or metastatic disease which includes fluoropyrimidine, irinotecan and oxaliplatin
    •Participants with known actionable molecular alterations or biomarker for which an approved therapy exists locally and is available, must have received at least 1 such therapy (eg, BRAF inhibitor-based therapy) for BRAF V600E mutated CRC
    Cohort C
    21. Has histologically or cytologically confirmed advanced pancreatic ductal adenocarcinoma that is metastatic
    Cohort D
    22. Have documentation of histopathological diagnosis of CCA (intrahepatic or extrahepatic) or gall bladder cancer (collectively called BTC) and have locally advanced (unresectable) or metastatic disease
    23. Participants with past or ongoing HCV infection will be eligible for the study. The treated participants must have completed their treatment at least 1 month before starting study intervention
    24. Participants with controlled HBV will be eligible as long as they meet the following criteria:
    •Antiviral therapy for HBV must be given for at least 4 weeks and HBV viral load must be less than 500 IU/mL before first dose of study drug. Participants on active HBV therapy with viral loads under 100 IU/mL should stay on the same therapy throughout study treatment.
    •Participants who are positive for anti-HBc, negative for HbsAg, and negative or positive for anti-HBs, and who have an HBV viral load under 100 IU/mL, do not require HBV antiviral prophylaxis
    25. Received at least 1 prior line of systemic therapy for unresectable or metastatic disease
    26. Has a Child-Pugh class A liver score within 7 days before first dose of study intervention
    1Presencia de un tumor sólido avanzad documentado histopatológica o citopatológicamente como sigue:
    Cohorte A CHC
    Cohorte B CCR (sin MSI-H/dMMR)
    Cohorte C ACDP
    Cohorte D CVB (incluye colangiocarcinoma intra y extrahepático y cáncer de vesícula biliar)
    2Progresión durante o después del tratamiento más reciente.
    3Presencia de enfermedad mensurable conforme a RECIST1.1
    4Envío de una muestra de tejido tumoral de archivo o de una biopsia reciente, lesión tumoral no irradiada previamente
    5Cumplimiento de los requisitos específicos de cada cohorte,incluidas las líneas previas de tratamiento
    6Varón o mujer de 18años o más en el momento de firmar el consentimiento informado
    7En el estudio podrán participar varones que se comprometan a todo lo siguiente durante el período de intervención con belzutifán o lenvatinib y durante al menos 7días después de recibir la última dosis de la intervención del estudio con belzutifán o lenvatinib:Abstenerse de mantener relaciones heterosexuales O Comprometerse a utilizar métodos anticonceptivos, a menos que se confirme la presencia de azoospermia
    8En el estudio podrán participar mujeres que no estén embarazadas ni en período de lactancia y que cumplan al menos una de lo siguiente:No es una mujer en edad fértil O Es una MEF y utiliza un método anticonceptivo eficaz
    9El participante ha otorgado su consentimiento informado documentado para el estudio.
    10Estado funcional del ECOG de 0-1 en los 7días previos al comienzo de la intervención del estudio
    11Presencia de una función orgánica adecuada
    12Presión arterial debidamente controlada definida como ≤150/90mmHg sin modificaciones de la medicación antihipertensiva en la semana previa al comienzo de los tratamientos del estudio
    Cohorte A
    13Diagnóstico de CHC confirmado mediante histología o citología
    14Presencia de un tumor en estadio C del BCLC o de un tumor en estadio B del BCLC no susceptible de tratamiento locorregional o resistente a dicho tratamiento y no susceptible de tratamiento curativo
    15Puntuación hepática de clase A de Child-Pugh en los 7días previos a la primera dosis de la intervención del estudio
    16Podrán participar en el estudio pacientes con infección por el VHC antigua o activa.Los participantes tratados deberán haber completado su tratamiento al menos un mes antes de iniciar la intervención del estudio
    17Podrán participar pacientes con infección controlada por el VHB siempre que cumplan los criterios siguientes:Tratamiento antiviral contra el VHB administrado durante al menos 4semanas y carga viral del VHB menor a 500UI/ml.Los participantes en tratamiento activo contra el VHB que presenten una carga viral menor a 100UI/ml deberán mantener el mismo tratamiento durante todo el período de tratamiento del estudio.Los participantes que den positivo para anti-HBc, - para HBsAg y - o + para anti-HBs y que tengan una carga viral del VHB menor a 100UI/ml no precisarán profilaxis antiviral contra el VHB
    18No haber recibido quimioterapia sistémica, incluido tratamiento anti-VEGF,anti-PD-1/PD-L1 o cualquier antineoplásico sistémico experimental
    Cohorte B
    19Documentación histopatológica de adenocarcinoma colorrectal avanzado y sin MSI-H ni dMMR
    20.Recepción de al menos dos líneas previas de tratamiento sistémico por enfermedad irresecable o metastásica.Los participantes con alteraciones moleculares susceptibles de actuación conocidas o biomarcadores para los que exista un tratamiento aprobado a nivel local que se encuentre disponible deberán haber recibido al menos un tratamiento de este tipo contra el CCR con mutación BRAF V600E
    Cohorte C
    21Presencia de un adenocarcinoma ductal de páncreas avanzado y metastásico confirmado histológica o citológicamente
    Cohorte D
    22Documentación del diagnóstico histopatológico de o cáncer de vesícula biliar y presencia de enfermedad localmente avanzada o metastásica.
    23Podrán participar en el estudio pacientes con infección por el VHC antigua o activa.Los participantes tratados deberán haber completado su tratamiento al menos un mes antes de iniciar la intervención del estudio
    24Podrán participar pacientes con infección controlada por el VHB siempre que cumplan los criterios siguientes:Tratamiento antiviral contra el VHB administrado durante al menos 4semanas y carga viral del VHB menor a 500UI/ml antes de administrar la primera dosis de la intervención del estudio.Los participantes en tratamiento activo contra el VHB que presenten una carga viral menor a 100UI/ml deberán mantener el mismo tratamiento durante todo el período de tratamiento del estudio.Los participantes que den positivo para anti-HBc, - para HBsAg y - o + para anti-HBs y que tengan una carga viral del VHB menor a 100UI/ml no precisarán profilaxis antiviral contra el VHB
    25Recepción de al menos una línea previa de tratamiento sistémico por enfermedad irresecable o metastásica
    26Puntuación hepática de clase A de Child-Pugh en los 7días previos a la primera dosis de la intervención del estudio.
    E.4Principal exclusion criteria
    1. Is unable to swallow orally administered medication or has a significant GI disorder that may affect study intervention absorption
    2. Has a history of a second malignancy that is progressing or has required active treatment within 3 years
    3. Has any of the following:
    • Hypoxia defined as a pulse oximeter reading <92% at rest, or
    • Requires intermittent supplemental oxygen, or
    • Requires chronic supplemental oxygen
    4. Has known CNS metastases and/or carcinomatous meningitis
    5. Has clinically significant cardiovascular disease within 6 months from first dose of study intervention, including NYHA Class III or IV congestive heart failure, unstable angina, myocardial infarction, cerebral vascular accident, undergone CABG or PTCA, or cardiac arrhythmia
    6. Prolongation of QTc interval to >480 ms
    7. Has a LVEF below the institutional (or local laboratory) normal range as determined by MUGA or ECHO
    8. Has urine protein ≥1 g/24 hours
    9. Has symptomatic pleural effusion (for example cough, dyspnea, pleuritic chest pain). A participant who is clinically stable after treatment for these conditions (including therapeutic thoraco- or paracentesis) is eligible
    10. Has preexisting ≥ Grade 3 GI or non-GI fistula
    11. Has moderate to severe hepatic impairment (Child-Pugh B or C)
    12. Has clinically significant hematuria, hematemesis or hemoptysis (>2.5 mL) of red blood, or other history of significant bleeding within 3 months before screening
    13. Has other clinically significant disorders such as:
    • Serious active nonhealing wound/ulcer/bone fracture
    • Requirement for hemodialysis or peritoneal dialysis
    14. Received colony-stimulating factors or transfusion within 28 days before study treatment initiation
    15. Has a known psychiatric or substance abuse disorder that would interfere with cooperation with the requirements of the study
    16. Has a history of hypersensitivity reaction to any of the investigational agent(s) included in this study
    Medical Conditions – Cohort A (HCC) Only
    17. Has had esophageal or gastric variceal bleeding within the last 6 months
    18. Has history of clinically diagnosed hepatic encephalopathy in the last 6 months unresponsive to therapy
    19. Has clinically apparent ascites on physical examination that is not controlled with medication
    20. Has inferior vena cava, or cardiac involvement of HCC based on imaging, verified by BICR
    21. Has bleeding or thrombotic disorders or use of factor X inhibitors or anticoagulants requiring therapeutic INR monitoring e.g. warfarin or similar agents. Treatment with low molecular weight heparin is permitted
    22. Has medical contraindications that preclude all forms of contrast enhanced imaging (CT or MRI).
    Prior/Concomitant Therapy
    23. Has received prior systemic anticancer therapy including investigational agents within 4 weeks before allocation
    24. Has received prior therapy with an anti-PD-1, anti-PD-L1, or anti-PD-L2 agent or with an agent directed to any costimulatory or coinhibitory T-cell receptor either alone or in combination with another agent in any treatment setting
    25. Has received prior radiotherapy within 2 weeks of start of study intervention
    26. Has received a live or live-attenuated vaccine within 30 days before the first dose of study drug
    27. Is currently receiving either strong or moderate inducers of CYP3A4 that cannot be discontinued for the duration of the study
    28. Is currently participating in or has participated in a study of an investigational agent or has used an investigational device within 4 weeks before the first dose of study intervention
    Diagnostic Assessments
    29. Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy or any other form of immunosuppressive therapy within 7 days prior the first dose of study medication
    30. Has an active autoimmune disease that has required systemic treatment in past 2 years
    31. Has a history of (noninfectious) pneumonitis that required steroids or has current pneumonitis
    32. Has an active infection requiring systemic therapy
    33. Has a known history of HIV infection
    34. Has a known history of Hepatitis B (defined as HbsAg reactive) or known active Hepatitis C virus
    35. For Cohorts A (HCC) and D (BTC): Has dual active HBV infection (HbsAg (+) and /or detectable HBV DNA) and HCV infection (anti-HCV Ab (+) and detectable HCV RNA) at study entry
    36. Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the study, interfere with the participant’s participation
    37. Has a known psychiatric or substance abuse disorder that would interfere with the participant’s ability to cooperate with the requirements of the study
    38. Has radiographic evidence of intratumoral cavitation, or invasion/infiltration of a major blood vessel.
    39. Has had an allogenic tissue/solid organ transplant
    40. Is pregnant or breastfeeding or expecting to conceive or father children during the study
    1Incapacidad de tragar medicación administrada por vía oral o presencia de un trastorno digestivo importante que pueda afectar a la absorción de la intervención del estudio.
    2Antecedentes de una segunda neoplasia maligna que está en progresión o que ha precisado tratamiento activo en los últimos 3años
    3Presencia de cualquiera de las circunstancias siguientes:Hipoxia definida como una lectura de pulsioxímetro<92%en reposo.Necesidad de oxigenoterapia intermitente u oxigenoterapia crónica
    4Presencia de metástasis en SNC y/o de meningitis carcinomatosa
    5Presencia de una enfermedad cardiovascular significativa en los 6meses previos a la primera dosis de la intervención del estudio,como insuficiencia cardíaca congestiva en claseIII oIV de la NYHA,angina de pecho inestable,infarto de miocardio,accidente cerebrovascular,práctica de una revascularización coronaria o ACTP o arritmia cardíaca.
    6Prolongación del intervalo QTcF por encima de 480ms
    7FEVI por debajo del intervalo normal del centro,determinada mediante MUGA o ECG
    8Proteinuria ≥1g/24horas
    9.Derrame pleural sintomático.Podrán participar candidatos que se encuentren clínicamente estables tras recibir tratamiento por estos procesos
    10Fístula gastrointestinal o no gastrointestinal de grado≥3preexistente
    11Insuficiencia hepática moderada o grave
    12Presencia de hematuria,hematemesis o hemoptisis clínicamente significativas de sangre roja u otros antecedentes de hemorragia en los 3meses previos a la selección
    13Otros trastornos clínicamente significativos como:
    Herida, úlcera o fractura ósea activa grave que no cicatriza o consolida
    Necesidad de hemodiálisis o diálisis peritoneal
    14Recepción de factores estimuladores de colonias o transfusión en los 28días previos al comienzo de la intervención del estudio
    15Trastorno psiquiátrico o por abuso de sustancias conocido
    16Antecedentes de reacción de hipersensibilidad a cualquiera de los fármacos del estudio,Enfermedades y procesos médicos:cohorteA
    17Hemorragia por varices esofágicas o gástricas en los 6últimos meses
    18Diagnóstico clínico de encefalopatía hepática en los 6últimos meses sin respuesta al tratamiento
    19Ascitis clínicamente evidente en la exploración física que no se controla con medicación
    20Invasión de la vena cava inferior o cardias por el CHC según los estudios de imagen confirmada mediante una ECIE
    21Presencia de trastornos hemorrágicos o trombóticos o uso de inhibidores del factor X o anticoagulantes que requieran vigilancia terapéutica del INR.Se permite el tratamiento con heparinas de bajo peso molecular
    22Presencia de contraindicaciones médicas que impidan realizar todas las formas de estudios de imagen con contraste.Tratamiento previo y concomitante
    23Recepción de un tratamiento antineoplásico sistémico previo, incluidos fármacos experimentales,en las 4semanas previas a la asignación
    24.Recepción de tratamiento previo con un fármaco anti-PD-1,anti-PD-L1 o anti-PD-L2 o con un fármaco dirigido contra cualquier receptor coestimulador o coinhibidor de los linfocitosT en monoterapia o en combinación con otro fármaco
    25Recepción de radioterapia en las 2semanas previas al comienzo de la intervención del estudio
    26Recepción de una vacuna de microorganismos vivos o atenuados en los 30días previos a la primera dosis del fármaco del estudio
    27ecepción activa de inductores potentes o moderados de la enzimaCYP3A4 que no puedan suspenderse durante el estudio
    28Participación activa o pasada en un estudio de un fármaco en investigación o uso de un dispositivo en investigación en las 4semanas previas a la administración de la primera dosis de la intervención del estudio
    Evaluaciones diagnósticas
    29Diagnóstico de inmunodeficiencia o recepción de tratamiento sistémico crónico con esteroides o cualquier otra forma de tratamiento inmunodepresor en los 7días previos a la primera dosis de la medicación del estudio
    30Presencia de una enfermedad autoinmunitaria activa que haya precisado tratamiento sistémico en los 2últimos años
    31Antecedentes de neumonitis que haya precisado la administración de esteroides o presencia de una neumonitis activa
    32Presencia de una infección activa con necesidad de tratamiento sistémico o por el virus de la inmunodeficiencia humana de la hepatitisB o infección activa conocida por el virus de la hepatitisC.Cohortes Ay D:Infección activa doble por el VHB en el momento de incorporación al estudio
    36Antecedentes o datos presentes de cualquier proceso, tratamiento o anomalía analítica que podría confundir los resultados del estudio, dificultar la participación para el posible participante
    37Presencia de un trastorno psiquiátrico o por abuso de sustancias que podría dificultar la capacidad del participante
    38Signos radiológicos de invasión o infiltración de un vaso sanguíneo importante o de cavitación intratumoral
    39Recepción de un alotrasplante
    40Embarazo,lactancia o intención de concebir o engendrar un hijo durante el estudio.
    E.5 End points
    E.5.1Primary end point(s)
    1. Number of Participants Who Experience at Least One Dose-limiting Toxicity (DLT)
    2. Number of Participants Who Experience at Least One Adverse Event (AE)
    3. Number of Participants Who Discontinue Study Treatment Due to an AE
    4. Objective Response Rate Per Response Criteria in Solid Tumors Version 1.1 (RECIST 1.1) as Assessed by Blinded Independent Central Review (BICR)
    1. Número de participantes que sufren al menos un evento de toxicidad limitante de dosis (DLT)
    2. Número de participantes que sufren al menos un evento adverso (AE)
    3. Número de participantes que discontinúan el tratamiento de estudio por un AE
    4. Ratio de respuesta objetiva por RECIST 1.1 evaluado por un comité central ciego (BICR)
    E.5.1.1Timepoint(s) of evaluation of this end point
    1. Up to ~21 days
    2. Up to ~45 months
    3. Up to ~44 months
    4. Up to ~45 months
    . Hasta ~21 días
    2. Hasta ~45 meses
    3. Hasta ~45 meses
    4. Hasta ~45 meses
    E.5.2Secondary end point(s)
    1. Duration of Response (DOR) Per RECIST 1.1 as Assessed by BICR
    2. Disease Control Rate (DCR) Per RECIST 1.1 as Assessed by BICR
    3. Progression-free Survival (PFS) Per RECIST 1.1 as Assessed by BICR
    4. Overall Survival (OS)
    5. ORR Per Modified Response Criteria in Solid Tumors Version 1.1 (mRECIST 1.1) for Hepatocellular Carcinoma (HCC) as Assessed by BICR
    6. DOR Per mRECIST 1.1 for HCC as Assessed by BICR
    7. DCR Per mRECIST 1.1 for HCC as Assessed by BICR
    8. PFS Per mRECIST 1.1 for HCC as Assessed by BICR
    1.Determinar la duración de la respuesta (DR) conforme a los criterios RECIST 1.1, según una ECIE.
    2.Determinar la tasa de control de la enfermedad (TCE) conforme a los criterios RECIST 1.1, según una ECIE.
    3.Determinar la supervivencia libre de progresión (SLP) conforme a los criterios RECIST 1.1, según una ECIE
    4.Determinar la supervivencia global (SG).
    5.Determinar los criterios de valoración de la eficacia conforme a los criterios mRECIST 1.1 específicos del carcinoma hepatocelular (CHC) (cohorte A), según una ECI
    6. DR conforme a los criterios mRECIST 1.1, según una ECIE.
    7. TCE conforme a los criterios mRECIST 1.1, según una ECIE.
    8. SLP conforme a los criterios RECIST 1.1, según una ECIE
    E.5.2.1Timepoint(s) of evaluation of this end point
    1. Up to ~45 months
    2. Up to ~45 months
    3. Up to ~45 months
    4. Up to ~45 months
    5. Up to ~45 months
    6. Up to ~45 months
    7. Up to ~45 months
    8. Up to ~45 months
    1. Hasta ~45 meses
    2. Hasta ~45 meses
    3.Hasta ~45 meses
    4. Hasta ~45 meses
    5.Hasta ~45 meses
    6. Hasta ~45 meses
    7. Hasta ~45 meses
    8. Hasta ~45 meses
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic Yes
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) Yes
    E.7.3Therapeutic confirmatory (Phase III) No
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled No
    E.8.1.1Randomised No
    E.8.1.2Open Yes
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group No
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial1
    E.8.3 The trial involves single site in the Member State concerned No
    E.8.4 The trial involves multiple sites in the Member State concerned Yes
    E.8.4.1Number of sites anticipated in Member State concerned3
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA29
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA No
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Australia
    Brazil
    Canada
    Chile
    Israel
    Korea, Republic of
    New Zealand
    Peru
    Turkey
    United States
    Belgium
    France
    Germany
    Ireland
    Italy
    Netherlands
    Spain
    E.8.7Trial has a data monitoring committee Yes
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    LVLS
    LVLS
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years3
    E.8.9.1In the Member State concerned months8
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years4
    E.8.9.2In all countries concerned by the trial months0
    E.8.9.2In all countries concerned by the trial days0
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 120
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 280
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations Yes
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception Yes
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state24
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 50
    F.4.2.2In the whole clinical trial 400
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    None
    Ninguno
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2021-10-05
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2021-07-08
    P. End of Trial
    P.End of Trial StatusOngoing
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